Adjustable drill guide and methods of use thereof

ABSTRACT

Drill guide assemblies are adjustable for proper alignment of drill holes in the glenoid with the drill holes in the coracoid during a Latarjet procedure. The drill guide has an aimer arm extending from the body of the drill guide which has a fixed angle with respect to a drill sleeve inserted through the guide. The aimer arm can move up or down relative to the drill sleeve while maintaining the fixed angle relative to the drill sleeve by actuation of a translation member on the body.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a divisional of U.S. application Ser. No.16/931,538, filed Jul. 17, 2020, entitled ADJUSTABLE DRILL GUIDE ANDMETHODS OF USE THEREOF, which in turn claims priority to and benefit ofU.S. Provisional Application No. 62/876,031, filed Jul. 19, 2019, thecontents of which are incorporated herein by reference in their entiretyfor all purposes.

FIELD

The present disclosure relates generally to surgical drill guides. Morespecifically, the present disclosure relates to adjustable drill guideassemblies for the positioning and orienting of bone tunnels to bedrilled in a glenoid bone.

BACKGROUND

A Latarjet operation, also known as the Latarjet-Bristow procedure, is asurgical procedure used to treat recurrent shoulder dislocations,typically caused by bone loss or a fracture of the glenoid. The Latarjetprocedure typically involves the removal and transfer of a section ofthe coracoid process, as well as its attached soft tissue, to theglenoid cavity. This placement of the coracoid acts as a bone blockwhich, combined with the transferred soft tissue, prevents furtherdislocation of the joint. During the procedure, holes are generallydrilled through both of the coracoid and the glenoid through whichscrews or sutures attached to anchors or buttons can be placed forsecuring the section of the coracoid to the glenoid.

Surgical drill guides can be used to place the holes in the glenoid neckat a fixed distance from the glenoid articulating surface to align withthe drill holes of the coracoid. However, misalignment between the twosets of holes can occur. When the holes are misaligned, thesuture/anchor or button constructs generally allow some tolerance inaligning the coracoid flush to the glenoid surface, because the suturehas play within the drill holes. However, when a surgeon wants to usescrews instead of the suture/anchor or button construct, retroactivealignment is not possible once the holes are drilled. Surgeons generallyaddress the misalignment by shaving down the thickness of the coracoidwith a burr. However, use of a burr can potentially cause cartilagedamage and affect the accuracy of the surface alignment between theglenoid and the coracoid, as well as affecting surface quality.

SUMMARY

Described herein is a drill guide assembly in which the drill guide isadjustable for properly aligning the holes in the glenoid with the holesin the coracoid in a Latarjet procedure. The drill guide has an aimerarm extending from the body of the drill guide which has a fixed anglewith respect to a drill sleeve inserted through the guide. The aimer armcan move up or down relative to the drill sleeve while maintaining thefixed angle relative to the drill sleeve by actuation of a translationmember on the body. The aimer arm can move in a stepped fashion in 1 mmincrements, or in a non-stepped fashion. A locking knob on the aimer armcan be used to lock the aimer arm at the desired position.Advantageously, the component parts of the drill guide assembly can bedisassembled for cleaning.

Examples of the drill guide assembly of this disclosure may include oneor more of the following, in any suitable combination.

In examples, a drill guide assembly of this disclosure includes anelongate body including a proximal end, a distal end and a longitudinalaxis extending between the proximal and distal ends. At least onechannel extends along the longitudinal axis of the body from theproximal end to the distal end. A sleeve is slidably disposed within theat least one channel. A distal end of the sleeve is configured to besecured to a first surface of a bone. An aimer arm extends distally fromthe body. A distal end of the aimer arm is configured to be secured to asecond surface of the bone. The aimer arm extends at a fixed angle withrespect to the sleeve. A vertical distance between the aimer arm and thesleeve is adjustable to a pre-selected distance by actuation of atranslation member on the body such that the aimer arm maintains thefixed angle with respect to the sleeve.

In examples, the assembly further includes a handle extending from alower surface of the body configured to be held by a user. In examples,the preselected distance is between 6 mm and 9 mm. In examples, the atleast one channel is two channels extending on opposing sides of theaimer arm, and a distance between the two channels is about 10 mm. Inexamples, the sleeve includes a bore extending from a proximal end to adistal end of the sleeve for the passage of a drill. In examples, theassembly further includes a locking mechanism for locking the sleeve ata predetermined position within the at least one channel. In examples,the proximal end of the sleeve includes a depth stop. A diameter of thedepth stop selected to be larger than a diameter of the channel forlimiting distal movement of the sleeve within the channel. In examples,the fixed angle is 10°. In examples, the distance between the aimer armand the sleeve is adjustable in a stepped or a non-stepped manner. Inexamples, the assembly further includes an alignment member extendingfrom an upper surface of the body adjacent the distal end of the body.The alignment member defines a plurality of longitudinal slots. Inexamples, the translation member is a rotatable wheel. In examples, theaimer arm extends through opposing ones of the plurality of slots alongthe longitudinal axis. A projection of the aimer arm is configured toserially engage the rotatable wheel such that the distance between theaimer arm and the sleeve is adjustable by rotation of the rotatablewheel by 90°. In examples, a pivot point of the rotatable wheel isoffset from a center of the rotatable wheel in both a horizontal and avertical direction. In examples, a proximal end of the aimer armincludes a locking knob for securing the aimer arm against the alignmentmember at the preselected distance. In examples, the assembly furtherincludes a compression spring disposed within the alignment member forbiasing the projection of the aimer arm against the rotatable wheel.

Examples of a method for positioning a bone tunnel in bone of thisdisclosure include positioning a distal tip of an aimer arm of a drillguide assembly against a first surface of a bone. The drill guideassembly includes an elongate body including a proximal end, a distalend and a longitudinal axis extending between the proximal and distalends. At least one channel extends along the longitudinal axis of thebody from the proximal end to the distal end. A sleeve is slidablydisposed within the at least one channel. A distal end of the sleeve isconfigured to be secured to a second surface of the bone. The aimer armextends from the body at a fixed angle with respect to the sleeve. Themethod also includes advancing the sleeve through the at least onechannel, whereby the bone is fixed between the distal tip of the aimerarm and the distal end of the sleeve. The method also includes actuatinga translation member on the body such that a vertical distance betweenthe aimer arm and the sleeve is adjusted to a preselected distance whilemaintaining the fixed angle with respect to the sleeve.

In further examples, the translation member is a rotatable wheel, andactuating the translation member includes rotating the rotatable wheelby 90°. In examples, the method also includes locking the aimer arm atthe preselected distance. In examples, the vertical distance between theaimer arm and the drill sleeve is adjusted in a stepped or a non-steppedmanner. In examples, the method further includes locking the sleevewithin the channel at a preselected position with a locking mechanism.In examples, the fixed angle is 10°. In examples, the preselecteddistance is between 6 mm and 9 mm.

These and other features and advantages will be apparent from a readingof the following detailed description and a review of the associateddrawings. It is to be understood that both the foregoing generaldescription and the following detailed description are explanatory onlyand are not restrictive of aspects as claimed.

BRIEF DESCRIPTION OF THE DRAWINGS

The disclosure will be more fully understood by reference to thedetailed description, in conjunction with the following figures,wherein:

FIGS. 1A and 1B are perspective views of an exemplary drill guideassembly of this disclosure;

FIG. 1C is a detailed view of the side wheel of the drill guide assemblyof FIGS. 1A and 1B;

FIG. 1D is an assembled view of the drill guide assembly of thisdisclosure;

FIG. 2 illustrates the use of the drill guide assembly of thisdisclosure;

FIG. 3 illustrates an alternative example of the drill guide assembly ofthis disclosure;

FIGS. 4A and 4B illustrate another alternative example of the drillguide assembly of this disclosure;

FIG. 5 illustrates another alternative example of the drill guideassembly of this disclosure;

FIGS. 6A and 6B illustrate yet another alternative example of the drillguide assembly of this disclosure; and

FIG. 7 illustrates another alternative example of the drill guideassembly of this disclosure.

DETAILED DESCRIPTION

In the description that follows, like components have been given thesame reference numerals, regardless of whether they are shown indifferent examples. To illustrate example(s) in a clear and concisemanner, the drawings may not necessarily be to scale and certainfeatures may be shown in somewhat schematic form. Features that aredescribed and/or illustrated with respect to one example may be used inthe same way or in a similar way in one or more other examples and/or incombination with or instead of the features of the other examples.

As used in the specification and claims, for the purposes of describingand defining the invention, the terms “about” and “substantially” areused to represent the inherent degree of uncertainty that may beattributed to any quantitative comparison, value, measurement, or otherrepresentation. The terms “about” and “substantially” are also usedherein to represent the degree by which a quantitative representationmay vary from a stated reference without resulting in a change in thebasic function of the subject matter at issue. “Comprise,” “include,”and/or plural forms of each are open ended and include the listed partsand can include additional parts that are not listed. “And/or” isopen-ended and includes one or more of the listed parts and combinationsof the listed parts. Use of the terms “upper,” “lower,” and the like isintended only to help in the clear description of the present disclosureand are not intended to limit the structure, positioning and/oroperation of the disclosure in any manner.

Referring now to FIG. 1A, an exemplary drill guide assembly 100 of thisdisclosure is shown in a perspective view. The assembly 100 includes aguide body 102 having a proximal end 102 a and a distal end 102 b. Anupper surface 102 c and a lower surface 102 d extend between theproximal end 102 a and the distal end 102 b of the body 102. A handle104 extends from the lower surface 102 d of the body 102 and isconfigured to be held by a user in a “pistol-style” configuration. Inalternative examples, not shown, the handle 104 is an in-line handle,formed substantially coaxially with the body 102. The body 102 furtherincludes at least one cylindrical channel 120 extending from theproximal end 102 a to the distal end 102 b of the body 102 for slidablyreceiving an elongate drill sleeve 134 (FIG. 1D). The drill sleeve 134is configured for the passage of a guidewire (not shown) for locatingthe bone tunnels to be drilled in the bone. In the example of FIG. 1A,two channels 120 are defined on opposite sides of the body 102configured for positioning two parallel bone tunnels through the bone.In examples, a distance between the channels 120 is about 10 mm,ensuring accurate and consistent placement of the bone tunnels about 10mm apart within the bone. An elongate aimer arm 110 extends distallyfrom the body 102 at about a 10° angle toward the longitudinal axis L ofa path defined by the channels 120 for insertion of the drill sleeve134. The aimer arm 110 includes a distal tip 116 with a spiked hook 118which is configured to contact a bone surface. In alternative examples,not shown, the distal tip 116 could be pointed or comprise a bluntedend, such as a spherical tip. The assembly 100 is configured such that avertical distance between the aimer arm 110 and the drill sleeve 134 isadjustable based on a pre-measured thickness of the bone to be drilledby actuation of a translation member on the body, such as a rotatablewheel 126, while still maintaining the 10° angle between the aimer arm110 and the drill sleeve 134. The upper surface 102 c of the body 102also includes at least one threaded opening 128 adjacent the proximalend 102 a for receiving a threaded ratchet pawl (not shown) for lockingthe drill sleeve 134 within the channel 120 at a desired position.

Turning now to FIG. 1B, in the example of the assembly 100, an alignmentmember 106 extends from the upper surface 102 c of the body 102 adjacentthe distal end 102 b. The alignment member 106 defines a plurality oflongitudinal slots 108 within the alignment member 106. The aimer arm110 extends through opposing slots 108 along the longitudinal axis andis vertically moveable within the slots 108 relative to the drill sleeve134. A proximal end of the aimer arm 110 includes a locking knob 114which can be used to secure the aimer arm 110 in the desired verticalposition within the slots 108. A projection 112 on the aimer arm 110extends through a third slot 108 and is configured to serially engage aflat edge of the rotatable wheel 126, as further described below. Acompression spring 122 is disposed within the alignment member 106between the aimer arm 110 and an upper knob 124. The spring 122 isconfigured to bias the projection 112 of the aimer arm 110 against therotatable wheel 126. In FIG. 1B, the rotatable wheel 126 is shownrotated 90° from the position of the rotatable wheel 126 shown in FIG.1A. In FIG. 1B, the spring 122 is also shown as more compressed and theaimer arm 110 in a higher vertical position than the spring 122 and theaimer arm 110 of FIG. 1A.

Turning now to FIG. 1C, the rotatable wheel 126 includes a pivot point127 that is offset from the center of the rotatable wheel 126 in both ahorizontal and vertical direction. For example, the pivot point 127 maybe disposed at a first distance A from a first flat edge 126 a of therotatable wheel 126 selected to be smaller than a second distance B froma second flat edge 126 b of the rotatable wheel 126 in a horizontaldirection. In examples, the first distance A may be 8 mm and seconddistance B may be 9 mm. Similarly, the pivot point 127 may be disposedat a third distance C from a third flat edge 126 c of the rotatablewheel 126 selected to be smaller than a fourth distance D from a fourthflat edge 126 d of the rotatable wheel 126 in a vertical direction. Inexamples, the third distance C may be 7 mm and the fourth distance D maybe 10 mm. In this manner, by a 90° rotation of the rotatable wheel 126,the distance between the aimer arm 110 and the drill sleeve 134 may beadjusted in a stepped manner in 1 mm increments from about 6 mm to about9 mm.

Turning now to FIG. 1D, the drill guide assembly 100 is shown with drillsleeves 134 inserted through the channels 120. Each drill sleeve 134includes a depth stop 136 at a proximal end of the drill sleeve 134. Thedepth stop 136 can be used by a surgeon to grasp and manipulate thedrill sleeve 134 during surgery. The depth stop 136 has a larger outerdiameter than that of the channel 120, such that when drill sleeve 134is inserted through the channel 120, the depth stop 136 prevents drillsleeve 134 from being inserted completely through the channel 120. Thedistal end of the drill sleeve 134 may be angled and include a pluralityof teeth 135 for securing the drill sleeve 134 against bone. A diameterof a proximal portion 134 a of the drill sleeve 134 is selected to belarger than a diameter of a distal portion 134 b of the drill sleeve134. The drill sleeve 134 has a cylindrical bore 138 (FIG. 2A) extendingthrough the drill sleeve 134 which provides a passageway for a guidewire(not shown). The proximal portion 134 a of the drill sleeve 134 alsoincludes a rack 140 in the form of a series of ratchet teeth or radialgrooves along one side of drill sleeve 134. A ratchet pawl 130 (FIG. 2A)is configured to engage with the rack 140 and lock the drill sleeve 134in a desired position within channel 120.

The use of the drill guide assembly 100 will now be described withreference to FIG. 2. The glenoid 132 may be initially prepared for theprocedure by rasping the inferior surface 132 a of the glenoid 132 forbetter attachment to the coracoid. Initially, drill holes 150 aredrilled in a center of the coracoid 151 at a distance from the lateralborder 151 a (typically 5 to 9 mm from the lateral border 151 a,depending on the width of the coracoid 151). The distance of the drillholes 150 to the lateral border 151 a of the coracoid 151 is measuredand the result is used to set the pre-selected distance of the aimer arm110 from the drill sleeve 134. For example, if the distance of the drillholes 150 from the lateral border 151 a of the coracoid 151 is 6 mm, thedistance of the aimer arm 110 from the drill sleeve 134 is selected tobe 6 mm. After an incision is made to introduce the assembly 100 intothe patient's shoulder, the surgeon adjusts the orientation of aimer arm110 until the hook 118 is placed on the inferior surface 132 a of theglenoid 132 to hold the aimer arm 110 in place, making sure that theunder surface of the aimer arm 110 is in full contact with glenoidcartilage. The drill sleeve 134 is then inserted through channel 120 ofthe assembly 100 so that the distal tip of the drill sleeve 134 is flushagainst the anterior surface 132 b of the glenoid 132. The drill sleeve134 is then locked into the channel 120 by the ratchet pawl 130.Subsequently, a drill (not shown) is inserted through the bore 138 ofthe drill sleeve 134 and drilled through the glenoid 132. The assembly100 is then removed from the patient's shoulder.

An alternative example of a drill guide assembly 300 is shown in FIG. 3.In the example of FIG. 3, a spring-loaded top knob 334 is used to adjustthe height of the aimer arm 310 within the slots 308 in a non-steppedmanner. The locking knob 314 is used to lock the height of the aimer arm310 in place. In an alternative example of a drill guide assembly 400,shown in FIGS. 4A and 4B, the alignment member 406 includes a firstplurality of teeth 440 spaced apart at a distance of about 1 mm. Theplurality of teeth 440 are configured to engage a second plurality ofteeth 442 (FIG. 4B) on the aimer arm 410 so that the height of the aimerarm 410 can be adjusted by 1 mm increments. A spring 422 is disposedwithin the alignment member 406 to ease the adjustment of the aimer arm410. The locking knob 414 is used to lock the height of the aimer arm410 in place.

Another example of a drill guide assembly 500 is shown in FIG. 5. In theexample of FIG. 5, the aimer arm 510 is connected via a rotatable joint544 to the guide body 502. The height of the aimer arm 510 is adjustedby moving the aimer arm 510 up or down relative to the guide body 502. Ascale 546 on the guide body 502 would indicate the degree of adjustmentin millimeters. The joint 544 could include a lock mechanism (e.g., athumb wheel) to lock the aimer arm 510 at the desired height.

An alternative example of a drill guide assembly 600 is shown in FIGS.6A and 6B. In the example of FIGS. 6A and 6B, a plurality of aimer arms610 having different heights (e.g., 5 mm, 6 mm, 7mm and 8 mm) could beconfigured to slide into a T-shaped slot 648 on a top surface 602 c ofthe guide body 602. A locking mechanism, such as a thumb wheel or aclick mechanism, would secure the aimer arm 610 in place. An alternativeexample of a drill guide assembly 700, shown in FIG. 7, uses aparallelogram joint configuration. In the example of FIG. 7, the fixedangle of the joint 744 is kept constant relative to the longitudinalaxis L of the drill sleeve for all offsets. The aimer arm 710 isconnected via the joints 744 and the lever arms 752 to the guide body702 and a height of the aimer arm 710 can be adjusted by moving theaimer arm 710 up and down relative to the body 702. An additional device(for example, a screw, an excenter, etc.), along with a scale on theguide body 702, could be used to adjust the aimer arm 710 in a steppedor non-stepped manner.

One skilled in the art will realize the disclosure may be embodied inother specific forms without departing from the spirit or essentialcharacteristics thereof. The foregoing examples are therefore to beconsidered in all respects illustrative rather than limiting of thedisclosure described herein. Scope of the disclosure is thus indicatedby the appended claims, rather than by the foregoing description, andall changes that come within the meaning and range of equivalency of theclaims are therefore intended to be embraced therein.

What is claimed is:
 1. A method for positioning a bone tunnel in bonecomprising: positioning a distal tip of an aimer arm of a drill guideassembly against a first surface of a bone, the drill guide assemblycomprising: an elongate body including a proximal end, a distal end anda longitudinal axis extending between the proximal and distal ends; atleast one channel extending along the longitudinal axis of the body fromthe proximal end to the distal end; and a sleeve slidably disposedwithin the at least one channel, a distal end of the sleeve configuredto be secured to a second surface of the bone; wherein the aimer armextends from the body at a fixed angle with respect to the sleeve;advancing the sleeve through the at least one channel, whereby the boneis fixed between the distal tip of the aimer arm and the distal end ofthe sleeve; and actuating a translation member on the body such that avertical distance between the aimer arm and the sleeve is adjusted to apreselected distance while maintaining the fixed angle with respect tothe sleeve.
 2. The method of claim 1, wherein the translation member isa rotatable wheel, and wherein the actuating the translation membercomprises rotating the rotatable wheel by 90°.
 3. The method of claim 1,further comprising locking the aimer arm at the preselected distance. 4.The method of claim 1, wherein the vertical distance between the aimerarm and the drill sleeve is adjusted in a stepped or a non-steppedmanner.
 5. The method of claim 1, further comprising locking the sleevewithin the at least one channel at a preselected position with a lockingmechanism.
 6. The method of claim 1, wherein the fixed angle is 10°. 7.The method of claim 1, wherein the preselected distance is between 6 mmand 9 mm.
 8. The method of claim 1, wherein positioning the distal tipof the aimer arm of the drill guide assembly comprises positioning witha handle extending from a lower surface of the body.
 9. The method ofclaim 1, wherein the at least one channel is two channels extending onopposing sides of the aimer arm, and wherein a distance between the twochannels is about 10 mm.
 10. The method of claim 1, wherein the sleevecomprises a bore extending from a proximal end to a distal end of thesleeve for passage of a drill.
 11. The method of claim 1, wherein aproximal end of the sleeve comprises a depth stop, a diameter of thedepth stop selected to be larger than a diameter of the at least onechannel for limiting distal movement of the sleeve within the at leastone channel.
 12. The method of claim 2, further comprising an alignmentmember extending from an upper surface of the body adjacent the distalend of the body, the alignment member defining a plurality oflongitudinal slots; wherein the aimer arm extends through opposing onesof the plurality of slots along the longitudinal axis, a projection ofthe aimer arm configured to serially engage the rotatable wheel suchthat the distance between the aimer arm and the sleeve is adjustable byrotation of the rotatable wheel by 90°.
 13. The method of claim 12,wherein a pivot point of the rotatable wheel is offset from a center ofthe rotatable wheel in both a horizontal and a vertical direction. 14.The method of claim 12, further comprising securing the aimer armagainst the alignment member at the preselected distance.
 15. The methodof claim 12, wherein the projection of the aimer arm is biased againstthe rotatable wheel by a compression spring disposed within thealignment member.